Compositions of improved sucralfate and sucrose octasulfate and method of use

ABSTRACT

A method use and compositions comprising sucralfate or sucrose octasulfate in combination with one or more anti-irritant agents in a weight to weight ratio of between 3:1 to 1:6 of sucralfate or sucrose octasulfate to anti-irritant agent, said composition being in either liquid or solid dose form, able to treat nausea and/or vomiting and/or diarrhea and/or erosions of mucosa or epithelium. Anti-irritant agents include antacid compounds, acid reducers, proton pump and phytotherapeutic herbals.

CROSS REFERENCE TO RELATED DISCLOSURE

This application is a continuation-in-part of application Ser No. 08/205383, filed Mar. 4, 1994 and now U.S. Pat. No. 5,447,918 granted 1995, Sep. 5, which was a continuation-in-part of application Ser. No. 08/077,715, filed Jun. 17, 1993, now abandoned, and which was a division of application Ser. No. 07/919,740, filed on Jul. 27, 1992, now abandoned.

This application is a continuation-in-part of application Ser No. 08/205383, filed Mar. 4, 1994 and now U.S. Pat. No. 5,447,918 granted 1995, Sep. 5, which was a continuation-in-part of application Ser. No. 08/077,715, filed Jun. 17, 1993, now abandoned, and which was a division of application Ser. No. 07/919,740, filed on Jul. 27, 1992, now abandoned.

REFERENCES CITED [REFERENCED BY] U.S. Patent Documents

3432489 March, 1969 Nitta et al. 260/234. 3838150 September, 1974 Sugiura et al. 536/121. 4975281 December, 1990 Harwood et al. 514/53. 5013557 May, 1991 Tai 424/493. 5084446 January, 1992 Baldoni et al. 514/53. 5234908 August, 1993 Szabo et al. 514/12. 5244670 September, 1993 Upson et al. 424/439. 5260304 November, 1993 Gergely et al. 514/58.

Other References

Evreux, The Am. J. of Med., 83 (suppl 3B):48-50, (Sep. 28, 1987).

1992 Physician' Desk Reference-pp. 1326-1327.

1986, 1990, 1991, 1992, 1999 AMA Drug Evaluations-p. 1:20-2.

1984 Compendium of Drug Therapy by Biomedical Information Corp p. 32:1.

BACKGROUND

There is a constant need in the pharmaceutical industry for improvements on formulations that enable enhanced healing or evaluations of clinical syndromes involving ulceration of epithelium, whether on mucosal surfaces or on epidermal surfaces. The primary improvement of previously reported agents is the use of specialized concentrations of functionalized carbohydrates and anti-irritants, preferably anti-inrritants of the group comprised of antacids, acid reducers, proton pump inhibitors and phytotherapeutical herbals, more preferably carboxylic acid type of antacids, most preferable oxalate, citrate, fumarate, succinate and malate. Functionalized carbohydrates include sucrose octasulfate and sucralfate.

Previously reported agents of U.S. Pat. No. 5,447,918, specifically Example 1 and Example 12 of that report, included sucrose octasulfate as the functionalized carbohydrates and was found in practice to have enhanced tissue adherence and coating when combined, as claimed in that report (claim 8 U.S. Pat. No. 5,447,918), with citrate. This observation was not limited to citrate but observed also with fumarate, succinate, malate, alpha-keto-gluturate, that is all Kreb's cycle acids (KCA).

In addition to this, combinations involving sucrose octasulfate or sucralfate formulated in accordance to Example 7 of the same report (U.S. Pat. No. 5,447,918) was noted to have unimpeded absorption of cimetidine, ranitidine, nizatidine and omeprazole from the gastrointestinal (GI) tract. Typically, when cimetidine, ranitidine, nizatidine or omeprazole are given with an antacid alone or given with sucralfate alone, the absorption of such compounds from the GI tract is diminished by 15-20% (Ref 24. J Clin Gastroenterl 12 Suppl 2: S54-63, 1990). However, in practice agents combined in accordance to Example 7 formulation of U.S. Pat. No. 5,447,918, showed no such dimunition of uptake, a novel characteristic, identified at that time and now claimed in this report.

Finally, combinations of sucrose octasulfate or sucralfate with KCA as formulated accordance to Example 8 formulation of U.S. Pat. No. 5,447,918 besides curing heartburn, also relieved nausea, vomiting and diarrhea in patients.

SUMMARY OF THE INVENTION

The present invention relates to novel pharmaceutical compositions of matter comprising of a) functionalized carbohydrates such as sucralfate or sucrose octasulfate combined with b) one or more irritant-relieving agents which when used allows functionalized carbohydrates to bind to tissue at a higher than usual concentration and permits concomitant uptake of cimetidine, ranitidine, nizatidine or omeprazole without interference to uptake.

Of particular note are compositions involving use of sucralfate or sucrose octasulfate with anti-irritants taken from a group that include 1) antacids, such as citrate, malate, magnesium hydroxide, calcium carbonate, malgadrate, glycine, magnesium carbonate, and other Kreb's cycle acids; 2) acid reducers like cimetidine, ranitidine, nizatidine, and famotidine; 3) proton pump inhibitors omeprazole, esomeprazole, pantoprazole, rabeprazole, and lansoprazole and 4) phytotherapeutic herbals like licorice, chamomile, saw palmetto, oryzonol, alginate, slippery elm bark.

The novelty of this invention is both the compositions as well as the method of use a) to improve potency of sucralfate, b) to permit concomitant administration of antacids compounds and proton pump inhibitors or histamine-2 blockers, and c) to relieve nausea, vomiting and diarrhea in patients who suffer from erosive as well as non-erosive gastroesophageal reflux syndrome (GERD).

COMPOSITIONAL CONCENTRATIONS OF COMPONENTS

The composition of this invention is in either liquid or solid dose form specifically formulated such that the weight/weight ratio for functionalized carbohydrates like sucralfate and sucrose octasulfate and the epigastralgic-relieving agents listed would range respectively from 10:1 to 1:10, preferably 5:1 to 1:6 , most preferably 3:1 to 1:6 in either liquid or solid dose form. The anti-irritant relieving agents are one or more of the following group that include 1) antacids, such as citrate, malate, magnesium hydroxide, calcium carbonate, malgadrate, glycine, magnesium carbonate, Kreb's cycle acids 2) acid reducers like cimetidine, ranitidine, nizatidine, and famotidine3) proton pump inhibitors omeprazole, esomeprazole, pantoprazole, rabeprazole, and lansoprazole and 4) phytotherapeutic herbals like licorice, chamomile, saw palmetto, oryzonol, alginate, slippery elm bark.

Of course the anti-irritant role of antacid group is three-fold. One purpose is to produce immediate neutralization of acid. A second purpose is to elevate the potency of functionalized poly/disaccharides, namely sucralfate and sucrose octasulfate, by promoting hydrogen-bonded and metal chelated polymerization of sucralfate or sucrose octasulfate in solution, which in turn when administered either orally or topically on ulcerated epithelial surfaces, higher concentrations of the functionalized poly/disaccharide would be achieved. This occurred when combining Kreb's cyle acids with sucralfate or sucrose octasulfate at weight to weight ratio 1:2 to 1:5. The third purpose is to mutually distract the antacid compounds and sucralfate or sucrose octasulfate compounds from electrostatic adsorption of concomitantly administered drugs. When both the antacid and sucralfate or sucrose octatasulfate are present between weight to weight ratios of 1:2 to 1:5 [antacid to sucralfate or sucrose octasulfate], the concomitantly administered acid reducers and proton pump inhibitors do not adsorb to either the antacid or to sucralfate or sucrose octatsulfate, thus remaining free in solution for uptake into the bloodstream from the GI tract.

The role of the acid reducers and proton pump inhibitors is to provide prolonged reduction in the hydrocholoric acid irritant in the GI tract. The role of the phytotherapeutic herbals is to improve the mucus gel barrier in the GI tract and to diminish inflammation on ulcerated epithelium.

ILLUSTRATION OF THE INVENTION

The following examples of this invention listed below are illustrative only; they are not at all intended to limit the scope of the invention, but rather to exemplify the practicality of this invention. These examples depict potential embodiments. The preferred embodiment of a poly[phosphoryl/sulfon]-ated carbohydrate-containing composition are those which contain sucralfate or sucrose octasulfate. It should be borne in mind, however, that other carbohydrate poly[phosphoryl/sulfon]-ates could be used as well. Additionally that the use of KCA's such as citrate, fumarate, succinate, oxalate, malate or alpha keto glutarate could be substituted with compounds that replace the carboxylate groups with carbamide, phosphonic, phosphate or even sulfonic, sulfonate substituents.

The following examples illustrate formulations wherein in the invention acts as a surface active high potency anti-irritant material.

EXAMPLE 1 Liquid Formulation

Ingredients mg/5 ml Sucralfate or Sucrose Octasulfate 250-500 Methyl Paraben USP 5-10 mg Propyl Paraben USP 5-10 mg Citrate, fumarate, succinate or Malate 100-175 mg Magnesium Hydroxide 175 mg Calcium Carbonate 175 mg Xanthum Gum 50 mg Starch 50 mg Sodium Saccharin 3.0-5.0 Sorbitol USP 200-350 mg Flavor q.s. Water 5.0 ml

EXAMPLE 2 Liquid Formulation with Special Emulsion Formula

Ingredients mg/5 ml Sucralfate or Sucrose Octasulfate 250-500 Methyl Paraben USP 5-10 mg Propyl Paraben USP 5-10 mg Citrate, Fumarate, Succinate or Malate 100-175 mg Simethecone 40-80 Calcium Carbonate/Magnesium Hydroxide 180 mg/150 mg Sodium Saccharin 3.0-5.0 Starch 50-200 mg Xanthum Gum 50 mg Sorbitol USP 200-350 mg Flavor q.s. Water 5.0 ml

In this example the xanthum gum and starch and sucrose octasulfate are in weight ratios vary from 1:1:10 to 1:4:8 and provide for an emulsion that is particularly smooth to taste, less gritty and chaulky when using magnesium hydroxide. The increase concentration of starch in the presence of xanthum gum and sucrose octasulfate appear key.

EXAMPLE 3 Acid Reducer Formulation

Ingredients Weight Sucralfate or Sucrose Octasulfate 250-500 mg Methyl Paraben USP 5-10 mg Propyl Paraben USP 5-10 mg Citrate, Fumarate, Succinate or Malate 100-175 mg Cimetidine, Ranitidine, Nizatidine or 20-400 Famotidine Calcium Carbonate 175 mg Sodium Saccharin 3.0-5.0 Sorbitol USP 200-350 mg Flavor q.s. Water 5.0 ml

EXAMPLE 4 Proton Pump Inhibitor Formulation

Ingredients Weight Sucralfate or Sucrose Octasulfate 250-500 mg Methyl Paraben USP 5-10 mg Propyl Paraben USP 5-10 mg Citrate, Fumarate, Succinate or Malate 100-175 mg Omerprazole, Esomeprazole, 10-40 Pantoprazole, Rabeprazole, and Lansoprazole Calcium Carbonate 175 mg Xanthum Gum 50 mg Starch 50 mg Sodium Saccharin 3.0-5.0 Sorbitol USP 200-350 mg Flavor q.s. Water 5.0 ml

EXAMPLE 5 Phytotherapeutic Formulation

Ingredients Weight Sucralfate or Sucrose Octasulfate 250-500 mg Methyl Paraben USP 5-10 mg Propyl Paraben USP 5-10 mg Citrate, Fumarate, Succinate or Malate 100-175 mg Licorice, Chamomile, Saw Palmetto, 10-400 Oryzonol, Alginate, Slippery Elm Bark Calcium Carbonate 175 mg Xanthum Gum 50 mg Starch 50 mg Sodium Saccharin 3.0-5.0 Sorbitol USP 200-350 mg Flavor q.s. Water 5.0 ml

LABORATORY ILLUSTRATION OF INVENTION Enhanced Sucralfate adherence/Potency

GI tract ulcers induced by ethanol in 12 laboratory rabbits was treated 1 day later by enteral administration of generic 10% sucralfate suspension (n=4), 10% sucralfate-aluminum hydroxide/magnesium hydroxide suspension (n=4) and Example 2 Formulation above (10% sucralfate) Sucralfate Antacid Suspension (n=4) at equal volumes. At 3 hours after administration, a 1 cm square section of GI tract were examined for the content of adherent aluminum both in the ulcer crater and in surrounding normal tissue. Concentration of adherent aluminum was assayed by atomic absorption spectroscopy then correlated to sucralfate concentration. TABLE 1 Enhanced Sucralfate Potency/Adherence SUCRALFATE CONCENTRATION ON G.I. LINING Three Hours Following Administration GASTRAFATE ™ GENERIC GENERIC EXAMPLE 2 Sucralfate Sucralfate-Antacid FORMULATION Suspension Suspension Emulsified Suspsension SUCRALFATE SUCRALFATE SUCRALFATE Conc Conc Conc Conc Conc μg/cm2 μg/cm2 on μg/cm2 μg/cm2 on μg/cm2 Conc μg/cm2 on Normal Ulcerated on Normal Ulcerated on Normal on Ulcerated GI Tract GI Tract GI Tract GI Tract GI Tract GI Tract (n = 4) (n = 4) (n = 4) (n = 4) (n = 4) (n = 4) 3.1 3.6 6.1 9.4 22.1 82.5 (+/−0.12) (+/−0.10) (+/−0.31) (+/−0.62) (+/−0.51) (+/−1.32)

Example 2 Formulation, manufactured by Sterling Foster Pharmaceutical and Glen Copel Pharmaceutical USA marketed under trade name Gastrafate appear to concentrate on normal un-injured GI tract 6-7×'s and 3-4×'s greater than generic sucralfate suspension and sucralfate antacid suspension. Gastrafate concentrate on acid-injured GI tract 23×'s greater and 8-9×'s greater than generic sucralfate suspension and sucralfate antacid suspension.

Similar results were seen using sucrose octasulfate instead of sucralfate.

Unimpeded Uptake of Acid Reducers

When given alone with either sucralfate or magnesium hydroxide/aluminum hydroxide antacid, fifteen to twenty percent, 15-20%, of dissolved cimetidine, ranitidine, and famotidine was not absorbed from the GI tract into the blood stream. However when sucralfate or sucrose octasulfate was coadministered with magnesium hydroxide/aluminum hydroxide, this diminution of uptake of cimetidine and ranitidine disappeared. It appears sucralfate and antacid at a weight:weight ratio of 4:1 to 2:1 mutually distract each other thus allowing dissolved histamine-2 blockers to be freely absorbed from the GI tract. TABLE 2 AUC for Cimetidine and Ranitidine With Sucralfate, Magnesium Hydroxide and Aluminum Hydroxide AUC for AUC for Cimetidine Ranitidine Cimetidine Alone 54.3 Ranitidine Alone 55.2 Sucralfate and 42.2 Sucralfate and 43.5 Cimetidine Ranitidine Sucralfate Magnesium 49.8 Sucralfate Magnesium 51.3 Hydroxide, Aluminum Hydroxide, Aluminum Hydroxide (4:1) Hydroxide (4:1) with Cimetidine with Ranitidine Sucralfate Magnesium 54.2 Sucralfate Magnesium 54.9 Hydroxide, Calcium Hydroxide, Aluminum Carbonate, (2:1) Hydroxide (2:1) with with Cimetidine Ranitidine

This phenomenon most likely occur with other co-administered compounds such as proton pump inhibitors, anti-microbials, anti-seizure drugs, and theophylline type products.

CLINICAL ILLUSTRATION OF INVENTION

In a double-blind, randomized placebo-controlled clinical trial of 50 patients, 16 with erosive GERD and 34 with non-erosive GERD, Example 2 Formulation was tested against placebo in the treatment of symptoms of GERD. Symptom relief included relief of chest pain, heartburn sensation, and acid regurgitation.

Unexpected and novel were the relief of nausea, the relief of vomiting and relief of diarrhea TABLE 3 Effects of Gastrafate Suspension vs Placebo Maximum Maximum Difference Difference Statistical SYMPTOMS Gastrafate Group Noticed Placebo Group Noticed Significance Chronic Severe Heartburn 3 months-2 years 3 mths-2 years Number of Daily Episodes 3 or more per day 3 or more per day Number Completed Study 26 24 Number with Erosive Disease  8  8 Number with Non-erosive 18 16 Relief of Heartburn 77% (20/26) In 3-4 days 21% (5/24) In 14-17 days p < 0.05 Relief of Acid Regurgitation 71% (10/14) In 6-8 days 38% (5/13) In 14-17 days p < 0.10 Relief of Chest Pain 82% (9/11) In 6-8 days 50% (5/10) In 14-17 days p < 0.04 Relief of Other Assoctd Symptoms 88% (14/16) In 6-8 days 53% (8/15) In 14-17 days p < 0.08 [Nausea Vomiting Dysphagia] Relief of Irregular Bowel Movements 80% (21/26) In 6-8 days 30% (7/24) In 14-17 days p < 0.05 [Loose Stools]

CONCLUSION AND SCOPE OF INVENTION

The invention is not limited to what is described in the above examples. It will be obvious to persons skilled in the art that alterations may be made without departing from the scope of this invention, which scope is defined by the following claims.

REFERENCES

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1. A method of relieving symptoms of erosive and non erosive gastrointestional mucosal irritation in mammals comprising administering to said mammals a composition comprising sucralfate or sucrose octasulfate in combination with one or more anti-irritant agents in a weight to weight ratio of between 3:1 to 1:6 of sucralfate or sucrose octasulfate to anti-irritant agent, said composition being in either liquid or solid dose form, wherein the symptoms include nausea and/or vomiting and/or diarrhea and wherein the anti-irritant agent is one or more taken from the group comprising of a) antacid compounds: magnesium hydroxide, calcium carbonate, malgadrate, aluminum hydroxide, glycine, magnesium carbonate, bismuth and Kreb's cycle acids such as citrate, fumarate, succinate, malate; b) acid reducers: cimetidine, ranitidine, nizatidine, and famotidine c) proton pump inhibitors omeprazole, esomeprazole, pantoprazole, rabeprazole, and lansoprazole; d) And phytotherapeutic herbals: licorice, chamomile, saw palmetto, oryzonol, alginate, slippery elm bark.
 2. A method of claim 1 wherein the inclusion of the anti-irritant agent selected from the group consisting Krebs cycle acids and combined with sucralfate or sucrose octasulfate at a weight to weight ratio of 1:2 to 1:5, promoting hydrogen-bonded and metal chelated polymerization of sucralfate and sucrose octasulfate thereby increasing the potency of sucralfate and sucrose octasulfate.
 3. A method of claim 1 wherein the inclusion of the anti-irritant agents selected from the group magnesium hydroxide, calcium carbonate, malgadrate, aluminum hydroxide, calcium carbonate, glycine, magaldrate, magnesium carbonate with sucralfate or sucrose octasulfate in a weight to weight ratios of 1:2 to 1:5 distracts sucralfate and sucrose octasulfate from adsorption to co-administered anti-irritants.
 4. A method of claim 1 wherein the anti-irritant agent comprising of one or more of the agents selected from the group consisting of: aluminum hydroxide, magnesium hydroxide, calcium carbonate, magnesium carbonate, malgadrate, glycine, bismuth, citrate, fumarate, succinate, malate are present in amounts sufficient to give 10 or more milliequivalents of acid neutralizing capacity per administered dose.
 5. A composition comprising sucralfate or sucrose octasulfate in combination with one or more anti-irritant agents in a weight to weight ratio of between 3:1 to 1:6 of sucralfate or sucrose octasulfate to anti-irritant agent, said composition being in either liquid or solid dose form, wherein the anti-irritant agent is one or more taken from the group comprising of a) antacid compounds: citrate, fumarate, succinate, malate, magnesium hydroxide, calcium carbonate, malgadrate, aluminum hydroxide, glycine, magnesium carbonate b) acid reducers: cimetidine, ranitidine, nizatidine, and famotidine c) proton pump inhibitors omeprazole, esomeprazole, pantoprazole, rabeprazole, and lansoprazole; d) and phytotherapeutic herbals: licorice, chamomile, saw palmetto, oryzonol, alginate, slippery elm bark.
 6. A composition of claim 5 wherein the inclusion of the anti-irritant agent selected from the group consisting Krebs cycle acids at weight-weight ratio between 1:2 to 1:5, Kreb's cycle acid to sucralfate or sucrose octasulfate, promoting hydrogen-bonded and metal chelated polymerization of sucralfate and sucrose octasulfate thereby increasing the potency of sucralfate and sucrose octasulfate.
 7. A composition of claim 5 wherein the inclusion of the anti-irritant agents selected from the group magnesium hydroxide, calcium carbonate, malgadrate, aluminum hydroxide, glycine, magaldrate, magnesium carbonate with sucralfate or sucrose octasulfate in a weight to weight ratios of 1:2 to 1:5 distracts sucralfate and sucrose octasulfate and the antacid from adsorption to co-administered anti-irritants.
 8. A composition of claim 5 wherein the anti-irritant agent comprising of one or more of the agents selected from the group consisting of: aluminum hydroxide, magnesium hydroxide, calcium carbonate, magnesium carbonate, malgadrate, glycine, bismuth, citrate, fumarate, succinate, malate are present in amounts sufficient to give 10 or more milliequivalents of acid neutralizing capacity per administered dose.
 9. A composition of claim 5 administered to inflamed or ulcerated mucosa or epithelium so as to accelerate healing.
 10. A composition of claim 5 administered to relieve nausea and/or vomiting and/or diarrhea.
 11. A composition of claim 5 administered to heal erosive and non-erosive gastroesophageal reflux disorder.
 12. A composition of claim 5 containing antimicrobial agents suitable for eliminating microbial-mediated processes in inflamed gastrointestinal tracts or on mucosal or epithelial surfaces.
 13. A composition of claim 5 containing emulsifying agents xanthum gum, starch, sucrose octasulfate at a weight ratios from 1:1:10 to 1:4:8 to provide an emulsion effect of diminished chalkiness when using magnesium hydroxide. 